Aims: To study the introduction of Haemophilus infl uenzae type b (Hib) vaccination in Sweden, and to identify factors promoting and inhibiting the process. Methods: The introduction of general childhood vaccination against Hib in Sweden in 1992-93 was studied using the Cultural Historical Activity Theory as a theoretical framework. Results: Five activity systems were found to be involved in the introduction process, the systems of vaccine production, government administration, news distribution, science, and disease prevention. The critical factors for introduction of the programme were found to be the vaccine product, conception of the disease, government economy and public decision-making. Conclusions: The results show that a broad range of non-biomedical aspects must be considered when a public health intervention such as a general vaccination programme is introduced.
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Mäkelä PH, Takala AK, Peltola H., Eskola J.Epidemiology of invasive Haemophilus infl uenzae type b disease. J Infect Dis1992; 165 (suppl 1): 2-6.
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Eskola J., Kähty H.Ten years experience with Haemophilus infl uenzae type b (Hib) conjugate vaccines in Finland. Rev Microbiol1996; 7: 231-41.
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Goldblatt D. , Miller E., McClosky N., Cartwright K.Immunological response to conjugate vaccines in infants: follow up study. Br Med J1998 ; 316: 1570-1.
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Adams WG, Deaver KA, Cochi SL, Plikaytis BD, Zell ER, Broome CV, et al. Decline of childhood Haemophilus infl uenzae type b (Hib) disease in the Hib vaccine era. JAMA1993; 269: 221-6.
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Garpenholt Ö. , Silfverdal SA, Hugosson S., Fredlund H., Bodin L., Romanus V., et al. The impact of Haemophilus infl uenzae type b vaccination in Sweden. Scand J Infect Dis1996; 28: 165-9.
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Jonsdottir KE , Steingrimsson O., Olafsson O.Immunisation of infants in Iceland against Haemophilus infl uenzae type b. Lancet1992 ; 340: 252-3.
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Engeström Y.Learning by expanding, an activity theoretical approach to development research [dissertation]. Helsingfors: Orienta - Konsultit, 1987.
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Engeström Y.Activity Theory and individual and social transformation. In: Engeström Y, Miettinen R , Punamäki RL, editors. Perspectives on Activity Theory. Cambridge: Cambridge University Press, 1999: 19-38.
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Engeström Y., Miettinen R.Introduction, Activity Theory: a well kept secret. In: Engeström Y, Miettinen R , Punamäki RL, editors. Perspectives on Activity Theory. Cambridge: Cambridge University Press, 1999: 1-16.
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Kuutti K.Activity Theory as a potential framework for human-computer interaction . In: Nardi B, editor. Context and consciousness. London: MIT Press , 1996: 17-44.
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Anonymous.Vaccineringsresultat: färre fall av hjärnhinneinfl ammation. (Outcome of vaccination: decrease of meningitis.)Tidningarnas Telegrambyrå (TT)1990 Sept 9.
17.
Eskola J., Rönnberg P-R., Mäkelä P.Haemophilus sjukdomarna nästan helt försvunna i Finland. (Haemophilus diseases nearly disappeared in Finland.)Läkartidningen1992; 89: 1893-4.
18.
Anonymous.Ekonomisk vinst vaccinera nyfödda mot farlig infl uensae. (Economic benefit of vaccination of infants against dangerous infl uenza.)Tidningarnas Telegrambyrå (TT)1992 June 22.
19.
Hay JW, Daum RSCost-benefit analysis of Haemophilus infl uenzae type b prevention: conjugate vaccination at eighteen months of age. Pediatr Infect Dis J1990; 9: 246-52.
20.
Sjöblom A.Bakterie drabbar barn, kostnader för obligatorisk vaccination avskräcker landsting. (Bacteria affects children, cost of mandatory vaccination a discouragement for County Councils.)Dagens Nyheter1992 June 12.
21.
Trollfors B.Lönsamt vaccinera alla spädbarn mot Haemophilus infl uenzae. (Profitable to vaccinate all infants against Haemphilus infl uenzae.)Läkartidningen1992; 89: 2428.
22.
Anonymous.Barnvaccin för dyr. (Childhood vaccination too expensive.)Ljusnan1992 June 13.
23.
Ahlbeck C.Nytt vaccin kan rädda 400 barn- men få föräldrar vet om att det finns. (New vaccine can save 400 children- but few parents are aware of the vaccine.)Expressen1992 June 30.
24.
Nordlund RAA triangle drama, authorities, citizens and media in crisis. Stockholm: National Board of Psychological Defence , 1994.
25.
Wallack L.Mass media and health promotion: promise and challenge. In: Atkin C, Wallack L, editors. Mass communication and public health: complexities and confl icts. Newbury Park: Sage, 1990: 41-52.
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27.
Lund ABSmittsomme sygdommer i dansk journalistik. (Communicable diseases in Danish journalism.) [dissertation]Copenhagen: Munksgaard, 1997.
